Neurological Test 1 Flashcards
Which assessment findings would you expect to see in the client who has a head injury close to where the spinal cord and brain connect?
all basic functions may be changed
Describe the primary function of the brain, spinal cord and cranial nerves.
The brain occupies the cranial activity, covered by membranes, fluids, and the skull bones, and is divided into: cerebrum, diencephalon, brain stem, and cerebellum.
Discuss the functions of the parietal, frontal, occipital, and temporal lobes of the brain.
Frontal: primary motor area, conscious control of skeletal muscles, personality, judgement.
Parietal: Primary sensory area. Interprets of touch, pain, and temperature.
Temporal: Auditory and olfactory areas. Also short and long term memory.
Occipital: Visual receiving and visual association area.
Describe how to assess the function of the 12 cranial nerves.
Oh Oh Oh To Touch And Feel Virgin Girls Vagina, Aah Heaven
List the nursing implications for the nurse caring for a client undergoing a CT scan with contrast. What teaching would you include for the patient?
refrain from consuming foods or liquids for 4 hours prior
check allergy to shellfish/iodine
assess renal function
no follow up care
What assessment finding would you expect in a client with a brain injury to the occipital lobe?
Visual transmissions and interpretation occur in the visual areas of the occipital lobe. These areas direct a person’s visual experiences.
Discuss the function of Broca’s area of the brain.
MOTOR SPEECH
a region in the frontal lobe of the dominant hemisphere (usually the left) of the hominid brain with functions linked to speech production.
Describe the main functions of the thalamus, cerebellum, hypothalamus, and medulla oblongata.
thalamus: the region of the brain that deciphers where to send messages. RELAY STATION FOR SENSORY IMPULES :)
hypothalamus: regulates body temperature. REGLATES HOMEOSTASIS
cerebellum: FUNCTIONS: COORDINATES VOLUNTARY MUSCLES, MAINTAINS BALANCE, MAINTAINS MUSCLE TONE.
medulla oblongata: CONTROLS MUSCLES OF RESPIRATION, REGULATES RATE AND FORCE OF HEART BEAT, CONTRACTION OF SMOOTH MUSCLE IN THE BLOOD VESSEL WALLS.
Discuss the function of the limbic system.
The location between the cerebrum and the diencephalon. It links the conscious functions of the cerebral cortex and the automatic functions of the brain stem.
involved in EMOTIONAL STATES AND BEHAVIOR
List the functions controlled by the medulla oblongata.
CONTROLS MUSCLES OF RESPIRATION
REGULATES RATE AND FORCE OF HEART BEAT
CONTRACTION OF SMOOTH MUSCLE IN THE BLOOD VESSEL WALLS
Explain the method for assessing pupil accommodation.
PERRLA
List three questions to ask the client to determine the intensity of pain.
how much pain do you have now?
what is the worst/best pain has been?
how would you rate your pain on a 0 - 10 scale?
Explain how to assess corneal reflexes.
Neurons in the brain communicate via electrical impulses and neurotransmitters. The nervous system is a complex collection of nerves and specialized cells known as neurons that transmit signals between different parts of the body.
Discuss the teaching for the client having seizures who is prescribed gabapentin (Neurontin).
monitor plasma levels keep seizure diary take as prescribes do not take extra doses avoid hazardous activities practice good oral hygiene avoid alcohol
List three principles about pain in a client.
Never question whether the pain is real or not.
Discuss the care plan and client education for the client undergoing a cerebral angiogram with contrast dye.
pre: ask if pregnant assess allergies to shellfish/iodine sign consent form NPO 4-8 hours prior don't wear jewelry mild sedative during procedure keep head immobilized assess kidney function void before the test metallic taste, warm sensation over the face, jaw, tongue, lips, and behind dye might be apparent
Post:
monitor clotting
restrict movement 8-12 hours
check pedal pulses
Discuss the teaching for the client undergoing an electroencephalogram. What does this diagnostic test measure.
noninvasive procedure to assess the electrical activity of the brain. Used to find: abnormalities in brain wave patterns, determine seizure activity, detect sleep disorders, behavior changes.
review meds
remove clips in hair
wash hair before procedure. no hair products
“sleep deprivation before test”
What is the purpose of the Glasgow Coma Scale? What assessment findings would you expect in the client with a Glasgow Coma Scale of 7?
Determines the level of consciousness (LOC) and to monitor response to treatment
List a medication that may be given to a client undergoing an MRI of the brain. Why?
Ativan used to relax the patient and to prevent claustrophobia.
What nursing actions should be included pre-procedure for a client receiving an MRI?
Question about any implants containing metal (pacemaker, orthopedic joints, IUD). remove jewelry.
Performed in supine position. Head must be secured to prevent any movement during the procedure.
List three nursing responsibilities for the client undergoing a lumbar puncture.
Client needs to remain in a “cannonball” position.
Sterile procedure.
Remove jewelry and client must wear gown.
Void before procedure.
Describe the nursing care of the client following a craniotomy.
treatment depends on the neurological status of the client after surgery
Which medications are used to treat trigeminal neuralgia?
carbamazepine oxycarbazepine gabapentin clonazepam phenytoin lamotrigine
Describe the symptoms of a “classic migraine” headache.
photophobia and phonophobia
nausea and vomiting
stress and anxiety
unilateral pain, often behind one ear
Define absence, myoclonic, and tonic-clonic seizures.
ABSENCE: most common in children, loss of consciousness lasting a few seconds, them client resumes baseline neurological functions
MYOCLONIC: are brief, shock-like jerks of a muscle or a group of muscles. “Myo” means muscle and “clonus” (KLOH-nus) means rapidly alternating contraction and relaxation—jerking or twitching—of a muscle. Usually they don’t last more than a second or two.
TONIC-CLONIC: usually lasts 1 to 2 minutes, but no more than 5. Will see an aura.
- Tonic: stiffening of muscles, loss of LOC, cessation of breathing
- Clonic: rhythmic jerking, irregular respirations, biting of cheek or tongue, bladder and bowel incontinence may occur.
List 6 signs and symptoms of increased intracranial pressure. What symptoms would you expect to appear first?
severe headache
deteriorating LOC, restlessness, irritability
dilated, pinpoint, or asymmetrical pupils
alteration in breathing
deterioration in motor function
seizures
List 3 things that can potentially increase intracranial pressure.
drug and alcohol use assault gunshot wounds falls motor vehicle accidents males under 25 years of age sports
List 3 nursing interventions that prevent increases in intracranial pressure.
elevating head 30 degrees
maintain airway
provide a calm, restful environment
meds
List one medication used to treat increased intracranial pressure. List 2 ways to know that the medication is effective.
Mannitol
Pentobarbital
Compare epidural hematoma and subdural hematoma.
EPIDURAL HEMATOMA: Accumulation of blood, usually from temporal artery, between the dura and the skin. Typically a “blow” to the side of the head.
SUBDURALHEMATOMA: Below the dura, slow forming. Caused by accumulation of blood usually from a torn vein on a brain’s surface.
Discuss the post-procedure teaching for the patient undergoing a lumbar puncture.
Monitor the puncture site. Have clients lie for several hours to ensure that the site clots.
If too much CSF is leaked out, SEVERE SPINAL HEADACHE could be there.
What are the therapeutic blood levels for phenytoin (Dilantin)?
10-20
When checking extra ocular eye movements, which cranial nerves are being assessed?
III
IV
VI
When calculating the Glasgow Coma score, the nurse is assessing the client’s response to which three areas?
Eyes Opening
Verbal
Motor response
Discuss the nursing interventions for the client having a seizure.
If standing/sitting, get client down to the floor and lay flat.
secure head
can place client on side while immobilizing head so they don’t aspirate
don’t touch them otherwise
when they are done, orient them back if they are confused
Discuss the teaching for the client prescribed phenytoin (Dilantin).
.
Discuss the nursing implications when administering carbamazepine (Tegretol).
.
Discuss the nursing implications when administering gabapentin (Neurontin).
.
Topiramate (Topamax) is used to treat which conditions? What are the nursing implications when administering this medication?
.
Discuss trigeminal neuralgia.
from the root of the trigeminal nerve and it becomes very painful.
unknown cause, but may be due to blood Bessel pressing on the nerve.
generally in older population
List the nursing interventions pre and post-op craniotomy surgery.
PRE: explain procedure, d/c aspirin products 72 hours prior
POST: keep head elevated 30 degrees in a neutral position, avoid straining activities, post-op bleeding and seizure activity are the greatest risks
Discuss the patient teaching for the client prescribed dexamethasone (Decadron).
glucocorticoids: NO NOT STOP SUDDENLY. TAPER.
Compare and contrast supratentorial and infratentorial brain tumors.
SUPRATENTORIAL: severe headache that improves over time visual changes seizure loss of voluntary movement change in cognitive function change in personality nausea without vomiting
INFRAENTORIAL: hearing loss or ringing in the ear facial drooping difficulty swallowing nystagmus ANS dysfunction ataxia hemiparesis
List 2 possible complications of intracranial pressure monitoring.
Brain herniation: downward shift of brian tissue due to cerebral edema.
Hematoma and intracranial hemorrhage
Neurogenic pulmonary edema
SIADH or DI
CSW
List 5 medications used to treat increased intracranial pressure.
Mannitol (Osmitrol) - osmotic diuretic Pentobarbital (Nembutal Sodium) Phenytoin (Dilantin) Morphine Sulfate Fentanyl (Sublimaze)
Which medication is often used to treat status epileptics?
benzodiazepines
List 2 possible complications of craniotomy surgery. What are the signs and symptoms of each?
SIADH and DI
How does the nurse assess for cerebral spinal fluid leakage?
CSF fluid will leave a yellowish ring around the droplet on the gauze/paper
List the signs and symptoms of suspected head injury.
deformity of the skull raccoon eyes unequal pupils spinal fluid leaking from ears battle's sign
What should be included in the care plan of the client with a seizure disorder?
safety
meds
List two things the nurse should assess while a patient is treated with mannitol (Osmitrol).
serum electrolytes and osmolality every 6 hours
monitor urine daily
Describe the method for assessing for a Romberg sign.
- The patient is asked to remove his shoes and stand with his two feet together. The arms are held next to the body or crossed in front of the body.
- The clinician asks the patient to first stand quietly with eyes open, and subsequently with eyes closed. The patient tries to maintain his balance. For safety, it is essential that the observer stand close to the patient to prevent potential injury if the patient were to fall. When the patients closes his eyes, he should not orient himself by light, sense or sound, as this could influence the test result and cause a false positive outcome.
- The Romberg test is scored by counting the seconds the patient is able to stand with eyes closed.
State the function of the nervous system.
Neurons in the brain communicate via electrical impulses and neurotransmitters. The nervous system is a complex collection of nerves and specialized cells known as neurons that transmit signals between different parts of the body.
What are the nursing considerations for the client receiving Morphine for pain post-operatively?
assess respirations
List the signs and symptoms of a cerebral aneurysm.
headache, can be severe
nausea or vomiting
bleeding, dizziness, light sensitivity, headache, stiff neck, or thunderclap headache
Discuss the nursing care plan and client teaching for the client with Bell’s palsy.
special eye care may be necessary
heat and massage
medications: prednisone
symptoms subside gradually over months
List the labs to be monitored for the client taking valproate (Depakote).
Liver
Kidney
CBC
Discuss what to teach the client with trigeminal neuralgia to prevent triggering pain.
make sure they take medication on schedule.
What is the first line choice of therapy for a client with trigeminal neuralgia?
anticonvulsant medications
List the signs and symptoms of trigeminal neuralgia.
excruciating jaw and face pain
triggers: slight touch of the face a breeze change in temp mouth full of food
Explain the definition of an aura.
An aura often occurs before a migraine or seizure. It may consist of flashing lights, a gleam of light, blurred vision, an odor, the feeling of a breeze, numbness, weakness, or difficulty in speaking
Which diagnostic test can be expected to be ordered to confirm brain death?
EEG
List three interventions for treating a migraine headache.
maintain a cool, dark, quiet environment
elevate head of the bed to 30 degrees
administer medications
List five medications for treating migraine headaches.
NSAIDS (ibuprofen, naproxen, acetaminophen
ANTI EMETIC (metoclopramide [Reglan] : relieve nausea and vomiting
TRIPTAN PREPARATIONS (zolmitripan [Zomig], sumatriptan [Imitrex], eletriptan [Relpax] : produce a vasoconstrictive effect
ERGOTAMINE PREPARATIONS W/CAFFEINE (cafergot, dihydroergotimine [Migranal] : narrows blood vessels to reduce inflammation
ISOMETHEPTENE (Midrin) : when nothing else works
List 5 foods that potentially trigger migraine headaches.
pickles caffeine beer wine aged cheese artificial sweeteners foods with MSG or preservatives
List 3 trigger factors for seizures.
increased physical activity excessive stress hyperventilation overwhelming fatigue actue alcohol ingestion excessive caffeine intake exposure to flashing lights specific chemicals (cocaine, aerosols, inhaling glue products)
Distinguish between parasympathetic and sympathetic nervous systems.
Sympathetic nervous system SPEEDS UP THE BODY
Parasympathetic system SLOWS DOWN THE BODY
